lancet-header

Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.

Severe Pain is Associated with Critical Illness and Mortality in Hospitalised Patients Across Africa: A Point Prevalence Study of 22 African Nations

23 Pages Posted: 16 Apr 2025

See all articles by Gillian J. Bedwell

Gillian J. Bedwell

University of Cape Town (UCT)

Romy Parker

University of Cape Town (UCT)

Victoria J. Madden

University of Cape Town (UCT)

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand

Muhammed Elhadi

Faculty of Medicine, University of Tripoli

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital

Babatunde Osinaike

University of Ibadan - Department of Anaesthesia

Christian Owoo

University of Ghana Medical School

Daniel Sottie

Korle Bu Teaching Hospital

Karima Khalid

Muhimbili University of Health and Allied Sciences

Adam Hewitt-Smith

Busitema University

Arthur Kwizera

Makerere University - Department of Anaesthesia and Critical Care

Fitsum Kifle

Debre Berhan University

Degsew Dersso Mengistu

Ministry of Health (Ethiopia)

Yared Boru Firissa

Aksum University - Comprehensive Specialized Hospital

Tirunesh Busha Gemechu

Addis Ababa University - Black Lion Hospital

Gaudencia Dausab

Ministry of Health and Social Services

Unotjari Kauta

Ministry of Health and Social Services

Kaveto Sikuvi

University of Namibia

Nahla Kechiche

University of Monastir - University Hospital of Monastir

Kélan Bertille Ki

Université de Ouagadougou - Centre hospitalier universitaire pédiatrique Charles de Gaulle

Martin Mukenga

Université de Kinshasa - Kinshasa University Hospital

Dolly Matondo Munlemvo

Université de Kinshasa - Kinshasa University Hospital

Mustapha Bittaye

Ministry of Health and Social Welfare, The Gambia

Abubacarr Jagne

University of The Gambia

Mohamed Abdinor Omar

Ministry of Health Somalia

Hassan Ali Daoud

Amoud University

Mohamed Faisal

University of Hargeisa

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University

Mpho Seleke

Ministry of Health, Lesotho

Tarig Fadalla

National Ribat University

Alshaima Koko

National Ribat University

Alemayehu Bedada

University of Botswana

Gilles Niengo Outsouta

Marien Ngouabi University

Marie Elombila

Marien Ngouabi University

Ahmed Rhassane El Adib

Cadi Ayyad University - University Hospital Center Mohamed VI

Meryem Essafti

University Hospital of Mohammed VI

Dino Lopes

Eduardo Mondlane University (UEM) - Maputo Central Hospital

Atilio Morais

Universidade Eduardo Mondlane

Pisirai Ndarukwa

Bindura University of Science Education

Newten Handireketi

Bindura University of Science Education

Fred Bulamba

Busitema University

Busisiwe Mrara

Walter Sisulu University

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University

Marian Kinnes

University of Cape Town (UCT)

Abdullahi Said Hashi

Recep Tayyip Erdogan Training and Research Hospital

Abigail Kusi Amponsah

Kwame Nkrumah University of Science and Technology

Aderonke Omobonike Akinpelu

University of Ibadan

Andrew Amata

Beit-CURE International Hospital

Aunel Mallier Peter

University of the Witwatersrand

Elizabeth Nwasor

Ahmadu Bello University (ABU)

Geremie Kalambayi

Université de Kinshasa - Kinshasa University Hospital

Hellen N. Kariuki

University of Nairobi

Nana Fening

University of the Witwatersrand

Nomaqhawe Moyo

University of Zimbabwe

Patrick Mukuna

Université de Kinshasa - Kinshasa University Hospital

Sean Chetty

Stellenbosch University

Sudarshanie Bechan

University of KwaZulu-Natal

Tania Pretorius

University of Cape Town (UCT)

Victor Bamidele Owoyele

University of Ilorin

Luyanduthando Mqadi

University of Cape Town (UCT)

Hanel Duvenage

Nutrition, Research and Development Manager, Safe Surgery South Africa

Gwendoline Arendse

University of Cape Town (UCT)

Luke Hannan

University of Cape Town (UCT)

Landon Myer

University of Cape Town (UCT) - Division of Epidemiology & Biostatistics

Carl Otto Schell

Uppsala University

Tim Baker

Muhimbili University of Health and Allied Sciences

Rupert M. Pearse

Queen Mary University of London - Critical Care and Perioperative Medicine Research Group

Bruce Biccard

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

More...

Abstract

Background: Pain in hospitalised patients is common and associated with secondary complications. There is little literature describing the prevalence and severity of pain in unselected samples of hospitalised patients across Africa. The relationships between pain severity and critical illness and mortality are unknown. 


Methods: This international prospective point-prevalence study in acute hospitals across Africa included all inpatients ≥18 years old. On a single day, investigators assessed patients’ worst pain in the preceding 24 hours on a 0 – 10 visual-numerical scale and vital signs. Severe pain was classified as pain ≥7/10. Patients were classified as critically ill if ≥1 vital sign(s) was out of range, according to predefined definitions. Mortality was assessed seven days later. Data are presented as mean (±SD), median [IQR], n (%) and odds ratios with 95% confidence intervals.

Findings:  We included 19 438 patients from 180 hospitals across 22 African countries and territories between September and December 2023. The median [IQR] age was 40 [29; 59] years, and 10 874/19 429 (56%) patients were female. The median [IQR] pain severity was 3 [0; 5], and 2 795/19 438 (14·4%) reported severe pain. Risk-adjusted multivariable regression models showed that severe pain was independently associated with critical illness (p < 0·001) and with seven-day mortality (p = 0·020). 

Interpretation: One in seven hospitalised patients across Africa reports severe acute pain. Severe pain is associated with both critical illness and mortality. Resources should be directed to effective and feasible strategies to manage acute pain and potentially impact clinical outcomes.

Keywords: Pain, Critical Care, Critical illness, Africa, Global Health, mortality, Epidemiology, Patient

Suggested Citation

Bedwell, Gillian J. and Parker, Romy and Madden, Victoria J. and Scribante, Juan and Elhadi, Muhammed and Ademuyiwa, Adesoji O. and Osinaike, Babatunde and Owoo, Christian and Sottie, Daniel and Khalid, Karima and Hewitt-Smith, Adam and Kwizera, Arthur and Kifle, Fitsum and Mengistu, Degsew Dersso and Firissa, Yared Boru and Gemechu, Tirunesh Busha and Dausab, Gaudencia and Kauta, Unotjari and Sikuvi, Kaveto and Kechiche, Nahla and Ki, Kélan Bertille and Mukenga, Martin and Munlemvo, Dolly Matondo and Bittaye, Mustapha and Jagne, Abubacarr and Omar, Mohamed Abdinor and Ali Daoud, Hassan and Faisal, Mohamed and Elfiky, Mahmoud and Seleke, Mpho and Fadalla, Tarig and Koko, Alshaima and Bedada, Alemayehu and Outsouta, Gilles Niengo and Elombila, Marie and El Adib, Ahmed Rhassane and Essafti, Meryem and Lopes, Dino and Morais, Atilio and Ndarukwa, Pisirai and Handireketi, Newten and Bulamba, Fred and Mrara, Busisiwe and Kluyts, Hyla and Kinnes, Marian and Hashi, Abdullahi Said and Amponsah, Abigail Kusi and Akinpelu, Aderonke Omobonike and Amata, Andrew and Peter, Aunel Mallier and Nwasor, Elizabeth and Kalambayi, Geremie and Kariuki, Hellen N. and Fening, Nana and Moyo, Nomaqhawe and Mukuna, Patrick and Chetty, Sean and Bechan, Sudarshanie and Pretorius, Tania and Owoyele, Victor Bamidele and Mqadi, Luyanduthando and Duvenage, Hanel and Arendse, Gwendoline and Hannan, Luke and Myer, Landon and Schell, Carl Otto and Baker, Tim and Pearse, Rupert M. and Biccard, Bruce, Severe Pain is Associated with Critical Illness and Mortality in Hospitalised Patients Across Africa: A Point Prevalence Study of 22 African Nations. Available at SSRN: https://ssrn.com/abstract=5217959 or http://dx.doi.org/10.2139/ssrn.5217959

Gillian J. Bedwell (Contact Author)

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Romy Parker

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Victoria J. Madden

University of Cape Town (UCT)

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand ( email )

Muhammed Elhadi

Faculty of Medicine, University of Tripoli ( email )

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital ( email )

Babatunde Osinaike

University of Ibadan - Department of Anaesthesia ( email )

Christian Owoo

University of Ghana Medical School ( email )

Accra
Ghana

Daniel Sottie

Korle Bu Teaching Hospital ( email )

Ghana

Karima Khalid

Muhimbili University of Health and Allied Sciences ( email )

UPANGA WEST
DAR ES SALAAM
Tanzania

Adam Hewitt-Smith

Busitema University ( email )

P.O Box 236
Tororo, 236
Uganda

Arthur Kwizera

Makerere University - Department of Anaesthesia and Critical Care ( email )

United States

Fitsum Kifle

Debre Berhan University ( email )

Degsew Dersso Mengistu

Ministry of Health (Ethiopia) ( email )

Yared Boru Firissa

Aksum University - Comprehensive Specialized Hospital ( email )

Tirunesh Busha Gemechu

Addis Ababa University - Black Lion Hospital ( email )

Addis Ababa
Ethiopia

Gaudencia Dausab

Ministry of Health and Social Services ( email )

Unotjari Kauta

Ministry of Health and Social Services ( email )

Kaveto Sikuvi

University of Namibia ( email )

Nahla Kechiche

University of Monastir - University Hospital of Monastir ( email )

Kélan Bertille Ki

Université de Ouagadougou - Centre hospitalier universitaire pédiatrique Charles de Gaulle ( email )

Martin Mukenga

Université de Kinshasa - Kinshasa University Hospital ( email )

Dolly Matondo Munlemvo

Université de Kinshasa - Kinshasa University Hospital ( email )

Mustapha Bittaye

Ministry of Health and Social Welfare, The Gambia ( email )

Abubacarr Jagne

University of The Gambia ( email )

Mohamed Abdinor Omar

Ministry of Health Somalia ( email )

Hassan Ali Daoud

Amoud University ( email )

Mohamed Faisal

University of Hargeisa ( email )

DHL Somaliland
Hargeisa
Somalia

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University ( email )

Kasr Al Ainy Faculty of Medicine
Manial
Cairo, 11432
Egypt

Mpho Seleke

Ministry of Health, Lesotho ( email )

Tarig Fadalla

National Ribat University ( email )

Alshaima Koko

National Ribat University ( email )

Alemayehu Bedada

University of Botswana ( email )

Private Bag 00702
4775 Notwane Rd
Gaborone
Botswana

Gilles Niengo Outsouta

Marien Ngouabi University ( email )

Marie Elombila

Marien Ngouabi University ( email )

Ahmed Rhassane El Adib

Cadi Ayyad University - University Hospital Center Mohamed VI ( email )

Meryem Essafti

University Hospital of Mohammed VI ( email )

Dino Lopes

Eduardo Mondlane University (UEM) - Maputo Central Hospital ( email )

Mozambique

Atilio Morais

Universidade Eduardo Mondlane ( email )

Maputo
Mozambique

Pisirai Ndarukwa

Bindura University of Science Education ( email )

Bindura
Zimbabwe

Newten Handireketi

Bindura University of Science Education ( email )

Fred Bulamba

Busitema University ( email )

P.O Box 236
Tororo, 236
Uganda

Busisiwe Mrara

Walter Sisulu University ( email )

South Africa

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University ( email )

Marian Kinnes

University of Cape Town (UCT)

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Abdullahi Said Hashi

Recep Tayyip Erdogan Training and Research Hospital

Turkey

Abigail Kusi Amponsah

Kwame Nkrumah University of Science and Technology ( email )

Kumasi
Kumasi
Ghana

Aderonke Omobonike Akinpelu

University of Ibadan ( email )

Department Of Mathematics, University Of Ibadan, I
Ibadan, Nigeria
Ibadan, LA 200005
Nigeria

Andrew Amata

Beit-CURE International Hospital

Turkey

Aunel Mallier Peter

University of the Witwatersrand ( email )

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Elizabeth Nwasor

Ahmadu Bello University (ABU)

P.M.B. 1044
Samaru
Zaria, WY Kaduna State 810107
Nigeria

Geremie Kalambayi

Université de Kinshasa - Kinshasa University Hospital

Democratic Republic of the Congo

Hellen N. Kariuki

University of Nairobi ( email )

4139-40200
Nairobi, 40200
Kenya

Nana Fening

University of the Witwatersrand ( email )

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Nomaqhawe Moyo

University of Zimbabwe ( email )

c/o Hall Farm, Wenhaston
Suffolk Ip19 9HE
Zimbabwe

Patrick Mukuna

Université de Kinshasa - Kinshasa University Hospital

Democratic Republic of the Congo

Sean Chetty

Stellenbosch University ( email )

Private Bag X1
Stellenbosch, 7602
South Africa

Sudarshanie Bechan

University of KwaZulu-Natal ( email )

Umbilo Road
Durban 4000, 4000
South Africa

Tania Pretorius

University of Cape Town (UCT)

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Victor Bamidele Owoyele

University of Ilorin ( email )

Luyanduthando Mqadi

University of Cape Town (UCT)

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Hanel Duvenage

Nutrition, Research and Development Manager, Safe Surgery South Africa ( email )

Gwendoline Arendse

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Luke Hannan

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Landon Myer

University of Cape Town (UCT) - Division of Epidemiology & Biostatistics ( email )

Carl Otto Schell

Uppsala University ( email )

Tim Baker

Muhimbili University of Health and Allied Sciences ( email )

UPANGA WEST
DAR ES SALAAM
Tanzania

Rupert M. Pearse

Queen Mary University of London - Critical Care and Perioperative Medicine Research Group ( email )

London
United Kingdom

Bruce Biccard

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine ( email )

Cape Town
South Africa

Click here to go to TheLancet.com

Paper statistics

Downloads
50
Abstract Views
204
PlumX Metrics